1104928746 NPI number — MS. TAMARA PELLANT M.S.,, L.P.C.

Table of content: MS. TAMARA PELLANT M.S.,, L.P.C. (NPI 1104928746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104928746 NPI number — MS. TAMARA PELLANT M.S.,, L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELLANT
Provider First Name:
TAMARA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,, L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104928746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ESSEX CT
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-464-9755
Provider Business Mailing Address Fax Number:
256-774-7579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ESSEX CT
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-464-9755
Provider Business Practice Location Address Fax Number:
256-774-7579
Provider Enumeration Date:
09/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1662 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51501383 . This is a "AMERICAN BEHAVIORAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 128680 . This is a "VALUEOPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 128680 . This is a "VALUEOPTIONS TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 220940 . This is a "COMPSYCH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1045501 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4035865 . This is a "BCBS OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-99825 . This is a "UBH ALLKIDS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 51008816 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 116534 . This is a "BEHAVIORAL HEALTH NETWORK" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 62-99825 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7286337 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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